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Roll over the sore spots to find out more about common female athlete injuries.

Female athletes can avoid being sidelined by injuries with proper prevention

by Monica Derevjanik and Mary Squillace
June 02, 2009


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The WNBA's Chicago Sky played against a team of male celebrities at Tuesday night's Battle of the Sexes Game at the University of Illinois at Chicago Pavilion. The Sky won 102 to 55.


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"We've definitely seen the number of females injuring their ACLs increase over time and that's because women now have the opportunity to compete more," said Dr. Michael Terry, an orthopedic surgeon at Northwestern Memorial hospital.


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Since Title IX was enacted in 1972, the number of female NCAA Varsity Athletes has risen by 403 percent, while the number of male athletes has risen only 23 percent, according to the American Association of University Women. The law states that no one on the basis of sex can be excluded from any education program or activity receiving Federal financial assistance.


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Staff members at athletic shoe store Universal Sole in the Near North Side can help athletes find the best shoe to avoid injury.


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The female athlete triad includes disordered eating, menstrual dysfunction and low bone mass, according to the Female Athlete Triad Coalition.


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Candice Dupree, who plays forward for the Chicago Sky, said she thinks there will always be a gap between male and female athletic abilities. "Women have evolved as players. They're taller. You're going to see a lot more who can dunk a basketball. But the same goes for men. They're evolving just as much as women are."

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One way to prevent sports-related injuries is to wear the right shoes. Learn about how to find the best fit for yourself.

Related Links

Female Athlete Triad CoalitionAmerican Association of University WomenChicago Sky WNBA

Can two play at this game?

Despite leading both teams in scoring during Tueday’s Battle of the Sexes game, Chicago Sky player Candice Dupree is unsure whether women will ever completely close the performance gap with men.

“With the ways males and females are developing these days, I think, there will always be some kind of gap,” she said. “Women have evolved as players. They’re taller, you’re going to see a lot more who can dunk a basketball, but the same goes for men. They’re evolving just as much as women are.”

This disparity largely comes down to biological differences between men and women.
Men, for one, are generally taller than women.

“Our 5’4”player has to take 60 steps to make it baseline to baseline, and someone who’s 6’7" only has to take 40 steps,” said Ann Crosby, strength and conditioning coach for the Sky.

But perhaps the greatest advantage that men have over women is increased levels of testosterone, which builds muscle mass.

“It’s been shown that women, no matter how much they work out…can never have the same upper body strength compared to men,” said Mark Hutchinson director of University of Illinois Chicago sports medicine service. So when it comes to power lifting or upper-body training, women will never reach the same performance levels as men.

Conversely, as girls hit puberty, an upsurge in levels of estrogen increases the amount of fatty tissue in a girl’s body. This, in turn, affects their strength and endurance.
“[Females] actually have to do more work and exercise to accomplish the same action as a male,” said Dr. Colleen Fitzgerald of the Rehabilitation Institute of Chicago.

However, hormonal differences won’t necessarily hinder women in sports.

“Depending on the sport, some body fat increased body fat may be an advantage – particularly cold weather sports or with endurance those energy stores might be helpful,” said Sharon Hame, basketball and volleyball trainer at University of California, Los Angeles.

In fact, women have been increasingly gaining ground on men when it comes to long-distance running. Since the 1970s women have shaved nearly 28 minutes off of their world record, compared approximately a five minute drop in the men’s record with the men’s record over roughly the same period of time.

“I think distance running probably is as equal as it can be because it takes less strength and more muscular or cardiovascular endurance,” said Mark Sleeper, a physical therapist and associate professor at the Feinberg School of Medicine at Northwestern University.

Experts also speculate that women may have the edge in gymnastics.

“Women have a relatively lower center of gravity compared to men,” Hutchinson said. “Men have a bigger upper torso and women’s weight is set a little bit lower, which allows them to perform gymnastics and tumbling activities better.”

But, according to Dr. Patrick Vaughan, spokesman for the American Academy of Orthopaedic Surgeons, “stronger” doesn’t necessarily translate to “better."

“I think men and women have different strengths,” he said. “I think sometimes the mistake that we make is judging females by the male standard we’re used to.”

When the WNBA’s Chicago Sky faced a team of men in Tuesday’s Battle of the Sexes game, 19-year-old Caitlin Staniec of Glenview wasn’t there to gawk at celebrities—she’s been attending games since the team started in 2006.

Outfitted in an autographed Sky jersey, she explained she has been playing basketball most of her life.

“I breathed basketball,” she said.

But her commitment to the sport came at a price. During her sophomore year of high school, Staniec tore her ACL. With surgery she was able to recover and rebound, going on to play at Cardinal Stritch University in Milwaukee.

“Bouncing back from something like that’s really great,” Staniec said.

Injuries like Staniec’s are becoming more widespread among competitive women. As the number of female athletes is on the rise, so are sports-related injuries.

Over the past three decades, the number of women in sports has soared. Between 1971 and 2001, the number of female athletes in the NCAA quintupled, growing from about 30,000 to over 150,000, according to the American Association of University Women.

“We’ve definitely seen the number of females injuring their ACLs increase over time, and that’s because women now have the opportunity to compete more and they’re doing it from a younger age,” said Dr. Michael Terry, an orthopedic surgeon at Northwestern Memorial Hospital in Chicago.

Injuries to the knee are especially prevalent in sports that require a lot of pivoting and accelerating, such as basketball and soccer. The most common injury in female athletes occurs in the anterior cruciate ligament, also known as the ACL. Damage to this ligament, which runs between the tibia and femur in the knee, can keep athletes from escalating their workout.

“In females the biggest injury we’re always worried about is ACLs,” said Nick Rubel, trainer for the Sky. “The incidence of non-contact ACL injuries in women is astronomical.”

Women are two to eight times as likely as men to sustain an ACL injury when playing the same sport, according to Dr. Patrick Vaughan, spokesman for the American Academy of Orthopaedic Surgeons in Rosemont.

“Many people can live the rest of their lives with an ACL injury,” said Dr. Mark Hutchinson, director of University of Illinois Chicago sports medicine service. Injured athletes will just have to replace sports like basketball and soccer with lighter, lower impact exercise such as jogging or cycling.

With an ACL injury, the knee may also develop recurrent instability, which can then lead to meniscus damage and then long-term arthritis, he added.

It could be structural differences in the lower body that contribute to women’s susceptibility to knee problems.
“In terms of injury patterns in the lower extremity, women have wider hips and tend to have a little bit more knock-knee position, which increases the risk of problems around the knee, particularly knee cap problems, patellar instability or overuse of the patella,” Hutchinson said.

Doctors and trainers also see a number of bone-related injuries among women, such as stress fractures—tiny, incomplete breaks in the bone. This may be derived from a combination of extensive training and disordered eating interfering with hormonal cycles.

“A lot of times women exercise to the point where they change their menstrual cycle,” Terry explained. This cuts down on the amount of estrogen women produce, which is needed to build bones, he added.

“When you have your period and it’s normal, you have estrogen being produced,” said Dr. Joel Press, director of the spine and sports rehabilitation center at the Rehabilitation Institute of Chicago. “When you’re not having your period, all of a sudden you don’t have the estrogen needed to help make good strong bones.”

In addition to causing painful stress fractures, which can halt an athlete’s career, this dip in estrogen actually chips away at bone density.

A combination of disordered eating, menstrual dysfunction and subsequent risk of osteoporosis can result in a syndrome known as the “female athlete triad.” But the triad is commonly missed by family, friends, trainers, coaches, and physicians for an extended period of time, Hutchinson said.

“The triad is actually a range of behaviors that may not seem pathologic to start: trying to lose weight or exercising extensively, but then gets out of hand with anorexia or pathologic eating behaviors or begins with a few lost menses due to exertion and weight loss followed by having only a few a year then absent menses,” he explained.

A female athlete with a stress fracture or infrequent or absent menses should wave a red flag to physicians, Hutchinson added. But coaches need to be on the look out for these red flags as well.

“I don’t think coaches are as aware as they can be or should be [about the female athlete triad]. It’s probably primarily because they require athletes to work hard and many of them require the athlete to not be overweight,” said Mark Sleeper, assistant professor of physical therapy at the Feinberg School of Medicine at Northwestern University.

Skipping a menstrual cycle might be difficult to change without medicine or a physician’s intervention, but there are steps female athletes, their trainers and coaches can take to ensure that girls are not setting themselves up for long-term injuries.

“The biggest problem is doing too much too fast,” Press said. “The gradual progression of activity is probably the single best way to avoid the problems you see in sports. In general the major injuries are related to overload.”
Sleeper added that strength and flexibility can ward off sports-related wear and tear.

“Overuse injuries as well as traumatic injuries can be prevented by maintaining proper strength,” added Sleeper, who frequently works with female gymnasts. “Strength enables the gymnast to carry out the repetitions while maintaining the muscle or motor control they need to do them accurately and safely.”

Despite its prevalence in competitive female athletes, ACL injuries among women are also highly preventable. A 2007 study in the British Journal of Sports Medicine by Holly Jacinda Silvers and Bert R. Mandelbaum of the Santa Monica Orthopaedic Sports Medicine and Research Foundation in California showed an 89 percent reduction in the rate of ACL injury occurrences when an intervention with a group of young basketball players was performed.

“We try to [imitate] what they’re doing in the game,” said Ann Crosby, strength and conditioning coach for the Sky. “ACL injuries 90 percent of the time occur in a deceleration mechanic – so on the way down from the jump, while you’re stopping, not necessarily when you’re starting in changing your cutting directions. So I try to focus on deceleration muscles and movement versus training muscles.”

By practicing jumping and landing motions, athletes can re-train their muscles to do it in the correct way, Press said.

So far the Sky’s training regiment seems to be working. Not only have the players successfully avoided ACL injuries, but they trounced the men, winning the Battle of the Sexes 102 to 55.

“We’re trying to take the steps to ensure that we don’t see those injuries,” said Rubel, knocking on the wooden floor of Sky’s practice court.